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Achievements and Future
Challenges in the surveillance of
Respiratory Viruses
San Jose, Costa Rica, 29-30th Jan,2013
• RSV Surveillance in Brazil
• Marilda M Siqueira –NIC/FIOCRUZ/Rio de Janeiro
OUTLINE
RSV DATA from Research Studies in Brazil
RSV DATA from Influenza Surveillance-2001-
2012
IMPROVING INFLUENZA AND OTHER
RESPIRATORY VIRUSES SURVEILLANCE
RSV DATA from Research Studies in Brazil
Rio Grande do Sul State(South)
Straliotto, et al Rev Soc Bras Med Trop. 2002 Jul-Aug;35(4):283-91.
Straliotto, et al Rev Soc Bras Med Trop. 2002 Jul-Aug;35(4):283-91.
Rio de Janeiro City (Southeasthern)
Peak at weeks 15 and 35 (from autumn to winter)
Nascimento JP et al., Rev Inst Med Trop Sao Paulo. 1991 Jul-Aug;33(4):287-96.
Ribeirão Preto, SP (Southeasthern)
Cintra et a., J Med Virol. 2001 Oct;65(2):408-12.
Salvador, BA (Northeastern)
Moura et al. Mem Inst Oswaldo Cruz. 2003 Sep;98(6):739-43.
Fortaleza, CE (Northeasthern)
Moura et al., 2006,
Am J Trop Med Hyg. 2006 Jan;74(1):165-7.
RSV DATA from Influenza Surveillance
1999-introduction of Flu Vaccine by MoH
Sentinel surveillance - ILI
Implemented in 2000- LabNet: IFAT
• 2000 to 2011 – 59 sentinel units-
Background
Influenza Surveillance
UNTIL 2011
Restricted to viral circulation
Irregular and heterogeneous
Provided restricted information for Surveillance and
Control Measures for Influenza and other respiratory
viruses.
We needed More samples, representativeness, virulence, subtyping
Guide antiviral treatment
Capacity to identify new viral subtype
IMPROVING INFLUENZA AND OTHER
RESPIRATORY VIRUSES SURVEILLANCE
Sentinels Units (SU) - 79 Municipalities
319 SU (ILI + SARI)
New organization - influenza surveillance system in Brazil
150 SU SARI
INFLUENZA LAB NET BRAZIL
2000-2009-IFAT
2009-2012- 13 StateLabs:rtPCR
REGIONAL REFERENCE LABORATORY
INSTITUTO EVANDRO CHAGAS- IEC/PA
: AP, AC, RR, AM,CE,PA,PB,PE,RN, MA e MS
NATIONAL REFERENCE LABORATORY FUNDAÇÃO OSWALDO CRUZ -FIOCRUZ/RJ
AL, BA, ES, PR,RJ, RS, SC ,SE,MG
REGIONAL REFERENCE LABORATORY INSTITUTO ADOLFO LUTZ – IAL/SP
:GO, DF, MT, PI, SP, RO e TO
State Central Laboratories - LACEN
Training
Health Professionals about influenza
surveillance
1,000 health professionals
Methodoly – ONLINE
Nationwide
New organization - influenza surveillance system in Brazil
SIVEP_GRIPE (ILI)
Distribuition the Positive Samples by IIF for age in Sentinels
Units. Brazil, EW -1 - 52/ 2012.
Fonte: SIVEP Gripe/SVS/MS.
10,0
35,9
44,5
37,7
34,4
2,2
7,2
13,3
9,3
0,0
5,1
6,5
2,9
5,1
4,9
1,2
2,0
2,3
4,5
8,2
7,5
3,9
5,2
3,9
4,9
19,5
28,8
19,1
22,6
23,0
54,5
15,7
12,7
16,9
24,6
0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 100,0
0 - 4
5 - 14
15 - 24
25 - 59
60 +
% CASES POSITIVES SAMPLES
AG
E
N = 1,391
Influenza A Influenza B Parainfluenza 1 Parainfluenza 2 Parainfluenza 3 Adenovírus VRS
SIVEP_GRIPE (ILI)
Distribution the Positive Samples for Respiratory Viruses
(Sentinels Units) Brazil, EW 01- 52/ 2012.
Fonte: SIVEP Gripe/SVS/MS.
0
20
40
60
80
100
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152
%
Num
ber
Posi
tive
Sam
ples
EW
N = 1,391
Influenza A Influenza B Parainfluenza 1 Parainfluenza 2 Parainfluenza 3 Adenovírus VRS % amostras positivas
RSV in SARI cases-RS State,South
0
50
100
150
200
250
300
350
400
450
500
0
3
6
9
12
15
18
21
24
27
30
33
36
39
42
45
48
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Nú
mero
de
vír
us
VSR Total de amostras/S.E.
RSV identified by IFAT in Sentinel Units
NORTH Region 2008 - 2012
0
10
20
30
40
50
60
70
80
90
100
0
5
10
15
20
1 7 13 19 25 31 37 43 49 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50
2008 2009 2010 2011 2012
VRS % Positividade pra qualquer vírus respiratório
N d
e V
RS
%P
ositivid
ade
Ano e SE
Fonte: Sivep_Gripe/CGDT/DEVEP/SVS/MS
0
10
20
30
40
50
60
70
80
90
100
0
5
10
15
20
1 7 13 19 25 31 37 43 49 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50
2008 2009 2010 2011 2012
RSV % Positivity for any RV
N of RSV
% Positividty
Year and EW
Source Sivep_Gripe/CGDT/DEVEP/SVS/MS
RSV identified by IFAT in Sentinel Units
NORTHEAST Region 2008 - 2012
0
10
20
30
40
50
60
70
80
90
100
0
5
10
15
20
1 7 13 19 25 31 37 43 49 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50
2008 2009 2010 2011 2012
VRS % Positividades para qaulquer vírus respiratório
N of RSV
%
Positivity
Ano e SE
Fonte: Sivep_Gripe/CGDT/DEVEP/SVS/MS
RSV identified by IFAT in Sentinel Units
SOUTHEAST Region 2008 - 2012
0
10
20
30
40
50
60
70
80
90
100
0
5
10
15
20
25
1 7 13 19 25 31 37 43 49 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50
2008 2009 2010 2011 2012
VRS % Positividade para qualuqer vírus respiratório
N d
e V
RS
%P
ositivid
ade
Ano e SE
Fonte: Sivep_Gripe/CGDT/DEVEP/SVS/MS
PILOT SURVEILLANCE in Belo Horizonte City
0102030405060708090
100110120130140150
menor 1 1 a 4 5 a 9 10 a 14 15 a 19 20 a 39 40 a 59 mais 60
Faixa Etária
A não subtipado
A(H1N1)2009
A(H3N2)
Flu B
Adeno
Para 1
Para2
Para3
VSR
n = 364
0102030405060708090
100110120130140150
menor 1 1 a 4 5 a 9 10 a 14 15 a 19 20 a 39 40 a 59 mais 60
Faixa Etária
A não subtipado
A(H1N1)2009
A(H3N2)
Flu B
Adeno
Para 1
Para2
Para3
VSR
n = 364
0 10 20 30 40 50 60 70 80 90
100 110 120 130 140 150
< 1 1 a 4
5 a 9 10 a 14 15 a 19 20 a 39 40 a 59 mais 60
Age Group
A not typed
A(H1N1)2009
A(H3N2)
Flu B
Adeno
Para 1
Para2
Para3
VSR
n = 364
Respiratory Viruses by age Group
Belo Horizonte,2012
Acknowledgements
• Walquíria Almeida-MoH Brazil
• Líbia O Souza- MoH Brazil
• Thiago Moreno Souza- NIC/FIOCRUZ
• Sirlene Pereira-MoH Brazil
• Tatiana Gregianini- LACEN RS
• Maria do Carmo Debur-LACEN PR